Provider Demographics
NPI:1326653312
Name:ANGEL HEART HEALTH SERVICES LLC
Entity Type:Organization
Organization Name:ANGEL HEART HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:LATASHA
Authorized Official - Middle Name:NICOLE
Authorized Official - Last Name:CONWAY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-416-5443
Mailing Address - Street 1:8111 E THOMAS RD STE 124
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85251-5876
Mailing Address - Country:US
Mailing Address - Phone:702-416-5443
Mailing Address - Fax:
Practice Address - Street 1:8111 E THOMAS RD STE 124
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85251-5876
Practice Address - Country:US
Practice Address - Phone:702-416-5443
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-15
Last Update Date:2020-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health